May 15, 2020

Axios Vitals

Good morning.

Axios is hosting a live virtual event on Medicaid and mental health. Axios co-founder Mike Allen and me today at 12:30pm ET for a conversation with Rep. Lauren Underwood (D-Ill.) and former acting administrator of the Centers for Medicare and Medicaid Services Andy Slavitt.

Today's word count is 873, or a 3-minute read.

1 big thing: Where coronavirus hospitalizations are falling
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Data: The COVID Tracking Project, Harvard Global Health Institute; Chart: Andrew Witherspoon/Axios

Coronavirus hospitalizations have declined in many states — another indication that social distancing has been effective at curbing the virus' spread, Axios' Bob Herman reports.

Why it matters: Hospitalizations are an important metric to watch to gauge the severity of the outbreak, especially because testing shortfalls have skewed some other measurements.

  • Those numbers aren't falling everywhere, and any approach to reopening needs to be carefully managed to prevent them spiking yet again.

Between the lines: Hospitals need to report this data to the Centers for Disease Control and Prevention daily, but we still don't have real-time numbers, due in part to the failures of the country's electronic health data infrastructure.

What the data show: Among the 40 states that have consistently provided data, COVID-19 hospitalizations are taking up a smaller percentage of all occupied hospital beds in many states, including hotspots like Connecticut, New Jersey and New York.

  • No more than 25% of hospital beds in any state are occupied by coronavirus patients.

Yes, but: Hospitalization rates aren't dropping, and in some cases are rising, in several states, including Colorado, Illinois, Minnesota, New Mexico and Virginia.

What's next: Hospitalizations are a lagging indicator of infection, because it takes a while for people to feel sick and seek care — so the coming weeks will provide a clearer picture of whether some states and hospitals are getting hammered again.

Go deeper: High-risk states are seeing fewer new coronavirus cases

2. Government-enforced social distancing works

Stringent social distancing measures imposed by state and local governments in the U.S. led to slower spread of the coronavirus, according to a new study in Health Affairs.

Why it matters: One of the most effective measures was shelter-in-place orders, which many states are lifting before public health experts say is safe.

Details: The study examined the impact of several social distancing measures.

  • It found that government-imposed shelter-in-place orders and closures of entertainment venues, gyms, bars, and restaurant dining areas had a significant impact on the spread of the virus.
  • But the study didn't find evidence that school closures or large event bans had an impact on spread.

The big picture: "Holding the amount of voluntary social distancing constant, these results imply 10 times greater spread by April 27 without [shelter in place orders] (10 million cases) and more than 35 times greater spread without any of the four measures (35 million)," the authors write.

3. The latest in the U.S.
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Data: The Center for Systems Science and Engineering at Johns Hopkins; Map: Andrew Witherspoon/Axios. This graphic includes "probable deaths" that New York City began reporting on April 14.

The CDC posted six new one-page tools on Thursday that advise businesses, restaurants and bars, schools, camps, child care centers and mass transit systems on how to safely reopen during the coronavirus pandemic.

Protests continued on Thursday against Michigan's stay-at-home order, alongside similar protests in suburban New York and Washington, D.C. Other demonstrations were held this week in North Carolina and Rhode Island.

Antibody tests that identify those who have previously contracted the coronavirus should not be used to determine immunity, the American Medical Association cautioned in a Thursday report.

The U.S. does not have a plan to distribute a vaccine for the coronavirus "in a fair and equitable manner" when one becomes available, Rick Bright, a former health official ousted from his position last month, told the House Energy and Commerce Committee on Thursday.

President Trump and Health and Human Services Secretary Alex Azar lashed out at Bright as he testified before Congress Thursday, dismissing his allegations about the administration ignoring his warnings about the pandemic as those of a "disgruntled employee."

OpenTable expects that one in four U.S. restaurants will go out of business due to closures enforced by stay-at-home orders and customers skittish in the face of the coronavirus pandemic, Bloomberg reports.

4. The latest worldwide
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Data: The Center for Systems Science and Engineering at Johns Hopkins; Map: Axios Visuals

Kutupalong refugee camps in Bangladesh reported their first coronavirus cases on Thursday, per the humanitarian organization International Rescue Committee and UN Refugee Agency.

Russia's surging coronavirus epidemic is now the world's second-largest, behind the U.S.

5. Let's talk about COBRA

In light of the estimate that 27 million workers and family members have potentially lost their health coverage during the pandemic, it's worth highlighting just how much the industry wants to keep people on their employer health plans, Bob writes.

Driving the news: House Democrats proposed taxpayer subsidies that would cover all COBRA premiums, but that's not close to happening yet. More pertinent: The federal government quietly made a change that extended when people can enroll in COBRA coverage. 

  • Instead of having to choose to enroll in COBRA within 60 days of notice, people now can enroll until 60 days after this coronavirus national emergency ends.

Between the lines: This could help people who would otherwise go uninsured, but it will also be a boon for hospitals and other health care providers.

  • It's legal for providers to pay for someone's COBRA premiums, and employers and insurance companies have to accept those payments.
  • That means providers now have a lot of time to enroll and directly subsidize people who are losing their jobs, and providers have a financial incentive to do so because commercially insured patients are by far the most lucrative.

The bottom line: COBRA is expensive because commercial health costs are expensive. If the industry doesn't get full COBRA subsidies like they want, this regulation change still serves as a small cushion.